Individual
STEVEN DWAYNE WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1118 ROSS CLARK CIR, SUITE 100, DOTHAN, AL 36301-3001
(334) 794-1148
(334) 793-1954
Mailing address
1118 ROSS CLARK CIR, SUITE 100, DOTHAN, AL 36301-3001
(334) 794-1148
(334) 793-1954
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
00015918
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000032731
—
AL
01
—
051032731
BCBS
AL
01
—
630991466
TRICARE
AL
Enumeration date
05/25/2006
Last updated
01/24/2012
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